Provider Demographics
NPI:1073040002
Name:FLETTRICH, LEON ALBERT IV (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEON
Middle Name:ALBERT
Last Name:FLETTRICH
Suffix:IV
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:729 N CARROLLTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-4708
Mailing Address - Country:US
Mailing Address - Phone:504-483-0955
Mailing Address - Fax:504-488-1847
Practice Address - Street 1:729 N CARROLLTON AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-4708
Practice Address - Country:US
Practice Address - Phone:504-483-0955
Practice Address - Fax:504-488-1847
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6743122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist